How The Power Dynamics of ER Make Us Wonder What A Good Doctor Was

 

When I was fifteen and gently making my way into watching adult dramas ER debuted on NBC. It took me a ridiculously long time to acknowledge that it was even a good show, much less a classic. I think by the time I had a chance to see the show in syndication starting in 2000, I began to gradually appreciate its genius. I never regularly watched it when it was on the air - in those pre-DVR/streaming days there were frequently series running against it on Thursdays at 10  - but after it left the air I have watched it several times in syndication in the last five to six years. Now I can realize that it was one of the best shows that TV has ever aired.

And I find myself wondering: why was I so resistant to the appeal that forty to fifty million people realized when the show was at its peak and that made it the Number 1 show on TV for nine years running (generally considered its creative highpoint)? Was it my contrary nature, refusing to accept that something that is embraced by the masses has any quality, something I have long accused too many of my fellow critics of being? I can’t rule that out, and those of you who’ve read my blog know that contrariness has not gone away with so many creative and popular shows of the last decade.

Was it my personal preference for Chicago Hope, the ‘other Chicago hospital drama’ that debuted the same day and time on CBS that year? I’ll admit that’s a possibility; there was a long period where I insisted David E. Kelley’s drama was superior to ER. That’s clearly not true, though I do hold it was an underrated masterpiece (and I may write about it in a different column)

Was it because I could not accept the ground-breaking formula that the show had, the constant ebb and flow of the major actors and so many of the arcs being set over several episodes? I concede that might be possible too, though again millions of viewers seemed to handle it just fine. At the time like most viewers I was still fixed in the episode of the week formula of network television and this pattern did not suit me; it was until Buffy and Angel that I began to leave my comfort zone and 24 that made me commit to the serialized storyline.

All of these are reasonable, but I think one of the biggest issues I had was one that was not apparent to me until fairly recently. Much of the problem was something that troubled me. It was that the cast member who were likable and personable tending to have shorter tenures on ER and the ones that were pricklier and more unpleasant stayed around far longer.

Now I need to make clear that none of the characters on ER ever were even close to the model of the antihero or antiheroines we see today: the show was groundbreaking but in the 1990s, those rules were not acceptable for network TV and even after they became so in the shows second half, the writers never went that far. No the problem was not one until recently that I was able to put into words. During ER’s fifteen years on the air, the doctors who were the most qualified to run the emergency department – or Cook County General, for that matter -  either got the authority to do so or if they did, never stayed in charge for long. By contrast, the most unpleasant people – the ones who you wondered why they chose medicine as a profession in the first place – would spend years climbing the ladder at the hospital and end up the bosses.

In the former case, the most prominent example was Mark Greene, played exceptionally by Anthony Edwards for eight seasons. In the pilot Mark was in the final year of his residency as Cook County and was clearly respected by most of the staff, even the acerbic Peter Benton. Famously when Dr. Morgenstern came to the ER after Carol Hathaway’s suicide attempt, he asked Mark’s opinion as to what to do and then said: “You set the tone, Mark.” And for the rest of his tenure that’s what Mark Greene did.

Once he was named an attending at the end of Season One, he had new responsibilities that frequently clashed with his personal relationships. From the start of his tenure, his friendship with Doug Ross (Clooney) suffered because of Doug’s tendency to flaunt authority and Mark being the authority. He reluctantly took Hathway’s advice to hire Kerri Weaver as chief resident, and ended up taking the brunt of abuse for it as she began to make her presence known. (We’ll get to that, believe me.)  When Weaver became an attending herself – based almost entirely by his recommendation – she spent the next three years as his rivals and eventually outmaneuvered him to become his boss.

Mark always had the better touch with personnel, was always the better teacher than Kerri, and was almost certainly the better doctor. In a perfect world Mark would have ended up running the ER instead of Kerri. Indeed, it’s worth noting that one of his bosses told him in Season 5 that he was willing to give him full tenure earlier than possible because he didn’t want to run the emergency department without him. (Ironically Edwards departed the series before that even became a possibility.) But because Mark was compassionate and understanding, he had something that Weaver never did friends and people who loved him. At the end of Season 5, he and Elizabeth Corday began a romantic relationship, would get married and have a baby daughter before Mark’s (very) untimely death.

Indeed he was married before the show began and spent the first season and a half trying to manage a marriage while his wife was working in Milwaukee with his daughter Rachel. In the middle of Season 2, his wife revealed she was having an affair and they got divorced. Mark spent a fair amount of time wallowing on that before he was able to move on, but because he had a support system already he was able to keep going beyond that. And because Mark frequently was willing to put the good of the ER before his own wellbeing, it hurt him in the leadership status.

Mark Greene wanted to be a doctor first and not management. Even before Weaver took over the ER, he tended to leave most management decisions to her. But he always put the ER first. I remember in the Season 3 premiere Weaver, in the name of efficiency, had introduced a system where a patients ID number was on the board and their symptoms were listed by a two-letter abbreviation. The entire staff was baffled by it (except Benton). At the end of the episode Greene made it clear that system was not going to exist anymore and went back to the old ways. We never see Weaver’s reaction but it’s worth noting she never tries anything like it again. In another case Greene and Weaver are asking to each instruct three med students who Cook County is trying to get come on board. Weaver gives them an instructional book of procedures and has them attend a series of lectures. Greene, by contrast, has all three spend the day helping him with patients and doing procedures. At the end of the episode none of Weaver’s students want to come to Cook County, but all of Greene’s have decided they want to consider it. The message is clear.

Mark Greene may be the best example of the idea that the people who should have the most power are the ones who don’t want it. The same can not be said of Kerri Weaver (Laura Innes) who was basically considered a bitch by almost everybody in the ER and most of the show’s viewers.

Unlike Mark Greene, who was more or less an open book, Weaver went out of her way to make sure no one learned about anything in her personal life. Her character had a crutch from the moment we met her, but she never told anybody at work about it for the first nine years her character was on the show. It wasn’t until Season 11 that we learned that it was a birth defect, and even then she only told someone who was a family member.

Weaver seemed almost proud at her ability to isolate people from the moment she landed in the ER. In her character’s second episode she got into a fight with Susan Lewis (Sherry Stringfield) that eventually boiled over. Mark disciplined Lewis by saying to assume that when Weaver did something he was speaking for her. But when Lewis left, he then defended her saying that she was one of the best residents she worked with. When Kerri said she didn’t like me talked to this way, in a rare burst of aspersion Mark called her out for her publicly disciplining her in front of a patient. It was resolved but the two never got along in either of Springfield’s tenures on the show.

The four seasons that George Clooney and Laura Innes tenure on ER overlapped the two were constantly at loggerheads. Some of it was because of Ross’ flaunting authority but there was clearly a sense of personal dislike. In Season 4 when Ross was working on his fellowship proposal, Weaver oversaw it told him of its flaws, and when he chose to ignore them went to the meeting where it was reviewed so she could humiliate him in front of his peers. When Ross called her out on it – considered that she’d left one of his patients in distress to do so – she dismissed his criticism, mainly because she had clearly decided  by then that Ross was unworthy of working in the ER.

There were times when Weaver could be outright duplicitous. When Morgenstern suffered a heart attack in the Season 4 premiere she visited him when he was in recovery – and under morphine – to go over some of the hospital day-to-day. A doped up Morgenstern basically gave her carte blanche to run the ER in his absence. This was a job that should have, by all rights gone to Mark, but at the time he was dealing with the fallout from his assault and basically signed off on it. When Morgenstern eventually resigned at the end of Season 4, Weaver naturally thought she would get the job – and was unsettled to learn that the bosses wanted to open a search. When the search took place in Season Five, Greene was named to the search committee and Weaver spent time kissing up to him. Greene actually voted for her on two occasions but in neither case did she get the job.

Despite everything Greene had done for her at the start of Season Six Weaver threw him under the bus. When Dr. Romano was being considered for chief of staff, Weaver told Greene this would be a mistake and convinced him to speak out at the meeting where it was decided. (I’ll get to the details later.) After it seemed like their was no dissent, Mark spoke up and then Kerri spoke out in favor of Romano. At every step Greene had been Kerri’s strongest ally and she probably guaranteed his career would never advance. As her reward Kerri was promoted to head of the ER.

Once she got the job Weaver cut what few personal ties she had. Carter, who’d been renting an apartment with her through Season 5, was told he would have to move out because she thought it was a conflict of interest. That same episode, she told Lucy Knight (Kellie Martin) that she wasn’t going to mentor her for the same reason. For much of the rest of her tenure on the show Weaver’s attitude became that of covering her own ass and isolating everyone else.

And she did some despicable things. In Season 7 when she was starting to explore her sexuality with Dr. Legaspi (Elizabeth Mitchell) who was out of the closet, Legaspi was accused of sexual harassment of a female patient. (We’ll get to this.) Because Weaver was terrified of having her sexual preferences exposed, she refused to defend her personally and their relationship ended. That same year when Mark was recovering from the removal of his brain tumor Weaver called the hospital and had his competency called into question. Corday publicly rebuked her and she was not invited to Greene’s wedding later that year (though it’s not clear whether he insisted on it or Elizabeth did)  As the series ended its second half, Weaver became more of a problem, at one point forcing Abby to take a job as head of the nurses “whether you want it or not”. During Season 8, when she left the ER in order to pursue a lead on an adoptive parent, a patient died while she didn’t have her pager. She fired Dave Melucci and suspended Deb Chen, all in the act of covering her ass.

But for of her flaws Kerri Weaver was capable of human connection on the job. She and Jeannie Boulet (Gloria Reuben) formed a bond in Season Two and when Weaver learned of her HIV positive diagnosis she kept her secret and protected her from the staff – including Greene. Their friendship lasted until Jeanie left the series in Season Six. She was also very close with Luka Kovac (Goran Visnjic) the first and for a while only member of the staff who knew of her changing sexuality. Luka openly supported her during a difficult time. Their relationship was problematic throughout the series but he clearly valued her opinion and considered her a friend. And she took the passing of Mark Greene very hard, realizing too late that she had considered the two of them rivals and that they wasted so much time.

The same, sadly, could not be said for the character of Robert ‘Rocket’ Romano (Paul McCrane). I viscerally disliked him when I first became aware of him in Season 5. But it actually gets worse when you learn his origin story as we realize what a horrible human being – and doctor – he was.

In his initial appearances in Season 4, it’s difficult to square the Romano we see with the one we are familiar with. There’s clearly an ego when it comes to surgery but he treats both Corday and Peter Benton with respect and appreciation. Perhaps its because he is only a surgeon and has no real power. Throughout the season, he is respectful both to Morgenstern (William H. Macy) and Donald Anspaugh (John Aylward) When he tries to ask Corday out at the end of Season 4, we actually feel bad for him when she turns him down. That immediately turns sideways when he chooses to end her fellowship in the next episode.

In the first half of Season Five while there are moments of humanity, the first sign of the monster comes when we hear him talking about Maggie Doyle (Jorja Fox) in veiled homophobic terms. Weaver is trying to arbitrate the dispute and comes to Corday, who knows of his history. Romano somehow learns about this and chooses, in vague terms, to threaten Corday and Benton with exposure. Corday retracts her response and the charge is dropped.

Not long after Romano ends up taking the job running the ER after the search has dried up. His first job is to essentially split up all of the major duties between Weaver and Greene and when Greene asks what he does, Romano tells him: “I supervise you.” Doyle is in the room when it happens and he makes a very deliberate slur on her sexual harassment charge. He has learned nothing from his horrid behavior and it will only accelerate from her.

He spends the rest of Peter Benton’s tenure at Cook County, continuously harassing him. He can’t understand why Benton is devoting time from surgery (read Romano) to try to be a father. At every opportunity for the next three seasons, he does every possible to harass and malign Benton. Once Benton goes over his head for surgery, Romano fires him, blackballs him in Chicago and forces him to come back for a job for lesser pay. Benton is forced to accept because he can not relocate. In Season 8 when Benton is dealing with his custody battle for his son, Romano refuses to do anything to make his life easier. Benton finally resigns to get a job with better hours. “You’re gonna play Mr. Mom?” he shouts in incomprehension.

There are signs of Romano’s bigotry in his early years but the longer he stays on the show the more omnipresent it becomes. He spends a lot of his final two seasons, not subtly racially maligning Michael Gallant and Greg Pratt, two African-American doctors. Once he actually says since one grew a beard, he can’t tell them apart. He instigates the search into Legaspi primarily because when he learns she’s a lesbian. When Weaver reveals her homosexuality, he spends much of the next season using it as a threat, then choosing to subtly harass her. And when Mark Greene comes back to hospital after the tumor is removed, he has no sympathy for his condition. “How much of your brain did they chop out?” he shouts and mocks his stammering because of his recovery. He bullies Weaver into making sure his competency gets tested – but takes none of the blame. (He’s in attendance at her wedding.)

  And his sole job once he becomes chief of staff at Cook County – a job he gets primarily because no one else wants it – is to hand off all of the major work on subordinates (primarily Corday) and spend every episode of ER for the next three years berating any move that a doctor makes that saves a life that might fall back on the hospital as a horrible job. Romano only wants the glory of the job and to blame everyone else for what goes wrong. You spend much of Romano’s first three seasons as a regular wondering why he got into medicine in the first place – it certainly wasn’t because of his love for his fellow man.

The most famous moment in his tenure was, of course, at the premiere of Season Nine when he lost his arm in a helicopter accident and had a reattached. It is telling that Romano not only didn’t want sympathy but resisted any chance to get it. All of his spare time was spent trying to get back into the OR and none of it on management. He did nothing to win anybody over. In the middle of Season Nine, Anspaugh approached him and tried to delicately tell him that he should share his duties. Romano refused to listen. “This is a gift, Robert,” Anspaugh said. “Take it.” “Right up the ass,” Romano said. Anspaugh then named Weaver chief of staff.

Romano was then forced back to running the ER. He was told he had three choices by Weaver: “this, teaching, or it’s out.” His first day back he started to discipline people, demanded to know who he could fire and who he couldn’t and isolated everybody possible. When Carter, more experienced then him, tried to talk Romano shouted: “This is my ER! That means everyone’s replaceable!” That night Romano got drunk at a bar, started taunting two men as intellectually beneath and got beat up.

Romano just kept digging in for the rest of the season he was there, berating everybody, becoming more racist and once using the excuse of a new artificial arm to grope random nurses. (Sam ended up throwing it in the trash.) When Romano was killed by another helicopter, it’s telling that even in the midst of an ER disaster, no one noticed or even cared about his absence.

When Mark Greene died, the entire ER and hospital was at his funeral. When Romano died, his memorial was practically empty, save for Corday, his mother and a few interns. In the aftermath Corday said: “He had no family. No wife. Nothing but this place.” My reaction at the time was simple. “He should have treated it better.”

When Romano died I was reminded of something was said about Ty Cobb: “He was a prick then, and he’s a prick now. The only difference is, now he’s a dead prick”  This was true even in the aftermath. When Carter, who was in Africa at the time, learned of Romano’s passing he didn’t seem that upset or even called him a friend. And the show made sure we never forgot what an asshole he was. In the final season when the show offered callbacks of almost every former regular, we saw a flashback of Mark Greene, sometime when his cancer had become fatal. Romano comes down to see him near the end of the flashback and tells him to get his chemo. “No one asked you to get cancer,” he tells Mark as if he’s the one being inconvenienced rather than the doctor who wants to console a woman who just lost her infant son.

Were Wells and the other staff writers trying to send a message in ER when they made it clear that the most unpleasant people on staff were the ones who managed to rise the highest in their careers? Were they trying to say that, as with everywhere else, in the field of medicine your skills as a doctor take a back seat to politics and ruthlessness when it comes to career advancement? That, like everywhere else, humanity and good manners did not serve you in your field even in healthcare? I have no idea. But as an underlying theme with one of the great shows on television, it adds layers of complexity that add reasons – as if you need them – to rewatch the show.